Safe move: Check with payers on differing coverage policies. If you overuse modifier 22 (Increased procedural services) you may face increased scrutiny from your payers or even the Office of Inspector General (OIG). But if you avoid the modifier entirely, you're likely missing out on reimbursement your pulmonologist deserves. How it works: Take a look at these three myths " and the realities " to ensure you don't fall victim to the modifier 22 catch-22. Myth 1: Morbid Obesity Means Automatic 22 Sometimes, a morbidly obese patient may require an anesthesiologist to perform fiberoptic intubation during a direct laryngoscopy. In this case, it may be appropriate to append modifier 22 to 31599 (Unlisted procedure, larynx). However, it's not appropriate to assume that just because the patient is morbidly obese you can always append modifier 22. "Modifier 22 is about extra procedural work and, although morbid obesity might lead to extra work, it is not enough in itself," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle. "Unless time is significant or the intensity of the procedure is increased due to the obesity, then modifier 22 should not be appended," warns Maggie Mac, CPC, CEMC, CHC, CMM, ICCE, director of best practices " network operations at Mount Sinai Hospital in New York City. There are some scenarios where you should consider whether modifier 22 is appropriate " such as unusual body habitus (obesity, unusually thin, tall, short, etc.), altered anatomy (congenital or due to trauma or previous surgery), and very extensive injury or disease " but without the documentation to back it up, do not automatically append modifier 22. You'll only be able to append modifier 22 when a procedure requires substantially greater additional time or effort because of the patient's obesity. Check the notes: "Although you can (in theory) add modifier 22 based only on the description of the work in the body of the note, practically it is impossible to get paid if you don't quantify the extra effort," Bucknam warns. Don't forget: Myth 2: A Little Extra Time Means Extra Pay "CPT does not provide specific direction as to the specific amount of time and/or percentage increase of time or work required to compliantly report modifier 22," says Marvel J. Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver. The typical rule of thumb, however, is your pulmonologist must spend at least 50 percent more time and/or put in at least 50 percent more effort than normal for you to append modifier 22. "There should be documentation of at least a 50 percent increase in work and/or time to justify use of modifier 22," Bucknam confirms. "Twice as much is better." Pointer: Caution: Bottom line: Myth 3: You Don't Need To Name Your Price Identifying the increased effort in your documentation, and on the claim (with modifier 22) does not automatically result in increased payment. If you do not increase your fee, you are likely to get the same payment result as if the modifier was not appended. Detail matters: